Evaluation of web-based, self-administered, graphical food frequency questionnaire.

Computer-administered food frequency questionnaires (FFQs) can address limitations inherent in paper questionnaires by allowing very complex skip patterns, portion size estimation based on food pictures, and real-time error checking. We evaluated a web-based FFQ, the Graphical Food Frequency System (GraFFS). Participants completed the GraFFS, six telephone-administered 24-hour dietary recalls over the next 12 weeks, followed by a second GraFFS. Participants were 40 men and 34 women, aged 18 to 69 years, living in the Columbus, OH, area. Intakes of energy, macronutrients, and 17 micronutrients/food components were estimated from the GraFFS and the mean of all recalls. Bias (second GraFFS minus recalls) was -9%, -5%, +4%, and -4% for energy and percentages of energy from fat, carbohydrate, and protein, respectively. De-attenuated, energy-adjusted correlations (intermethod reliability) between the recalls and the second GraFFS for fat, carbohydrate, protein, and alcohol were 0.82, 0.79, 0.67, and 0.90, respectively; for micronutrients/food components the median was 0.61 and ranged from 0.40 for zinc to 0.92 for beta carotene. The correlations between the two administrations of the GraFFS (test-retest reliability) for fat, carbohydrate, protein, and alcohol were 0.60, 0.63, 0.73, and 0.87, respectively; among micronutrients/food components the median was 0.67 and ranged from 0.49 for vitamin B-12 to 0.82 for fiber. The measurement characteristics of the GraFFS were at least as good as those reported for most paper FFQs, and its high intermethod reliability suggests that further development of computer-administered FFQs is warranted.

New technology in dietary assessment: a review of digital methods in improving food record accuracy.

Methods for conducting dietary assessment in the United States date back to the early twentieth century. Methods of assessment encompassed dietary records, written and spoken dietary recalls, FFQ using pencil and paper and more recently computer and internet applications. Emerging innovations involve camera and mobile telephone technology to capture food and meal images. This paper describes six projects sponsored by the United States National Institutes of Health that use digital methods to improve food records and two mobile phone applications using crowdsourcing. The techniques under development show promise for improving accuracy of food records.

Web-enabled and improved software tools and data are needed to measure nutrient intakes and physical activity for personalized health research.

Food intake, physical activity (PA), and genetic makeup each affect health and each factor influences the impact of the other 2 factors. Nutrigenomics describes interactions between genes and environment. Knowledge about the interplay between environment and genetics would be improved if experimental designs included measures of nutrient intake and PA. Lack of familiarity about how to analyze environmental variables and ease of access to tools and measurement instruments are 2 deterrents to these combined studies. This article describes the state of the art for measuring food intake and PA to encourage researchers to make their tools better known and more available to workers in other fields. Information presented was discussed during a workshop on this topic sponsored by the USDA, NIH, and FDA in the spring of 2009.

Relative validity of the Iowa Fluoride Study targeted nutrient semi-quantitative questionnaire and the block kids' food questionnaire for estimating beverage, calcium, and vitamin D intakes by children.

OBJECTIVE: Food frequency questionnaires are commonly developed and subsequently used to investigate relationships between dietary intake and disease outcomes; such tools should be validated in the population of interest. We investigated the relative validities of the Iowa Fluoride Study targeted nutrient semi-quantitative questionnaire and Block Kids' Food Questionnaire in assessing beverage, calcium, and vitamin D intakes using 3-day diaries for reference. DESIGN: Cross-sectional. SUBJECTS: Children who completed Iowa Fluoride Study nutrient questionnaire at age 9.0+/-0.7 years (n=223) and/or the Block Kids' Food Questionnaire at age 8.3+/-0.3 years (n=129) and 3-day diaries during similar time periods. MAIN OUTCOMES: Intakes of beverages, calcium, and vitamin D. STATISTICAL ANALYSES: Spearman correlation coefficients, weighted kappa statistics, and percentages of exact agreement were used to estimate relative validities. RESULTS: Correlations between milk intakes (r=0.572) reported on diaries and the Iowa Fluoride Study nutrient questionnaires were higher than correlations for 100% juice, juice drinks, soda pop, and water (r=0.252 to 0.379). Correlations between milk intakes (r=0.571) and 100% juice intakes (r=0.550) reported on diaries and Block Kids' Food Questionnaires were higher than correlations for other beverages (r=0.223 to 0.326). Correlations with diaries for calcium (r=0.462) and vitamin D (r=0.487) intakes reported on Iowa Fluoride Study nutrient questionnaires were similar to correlations with diaries for calcium (r=0.515) and vitamin D (r=0.512) reported on Block Kids' Food Questionnaires. Weighted kappa statistics were similar between the Iowa Fluoride Study nutrient questionnaires and the Block Kids' Food Questionnaires for milk, 100% juice, and vitamin D, but were higher on the Iowa Fluoride Study nutrient questionnaires than on the Block Kids' Food Questionnaires for calcium. Percentages of exact agreement were higher for calcium, but lower for vitamin D for intakes reported on the Iowa Fluoride Study nutrient questionnaires compared to the Block Kids' Food Questionnaires relative to diaries. CONCLUSIONS: Both the Iowa Fluoride Study nutrient questionnaire and the Block Kids' Food Questionnaire provide reasonable estimates of milk, calcium, and vitamin D intakes when compared to 3-day diaries.

Development of the Iowa bone nutrient food frequency questionnaire based on data from the US Department of Agriculture Continuing Survey of the Food Intake by Individuals.

An easily administered food frequency questionnaire (FFQ)/dietary screener was developed for current (adult) and retrospective (adolescent) intakes of nutrients important for bone development and maintenance. This tool quantified serving sizes and nutrients from foods using gender and age specific techniques. Nutrients of interest were calcium, vitamin D, caffeine and alcohol, and 15 categories of foods were selected for inclusion based on frequency of intake and nutrient density. Calcium-contributing foods were selected from published dietary intake assessment tools. Foods contributing vitamin D, caffeine and alcohol were selected based on nutrient density and Midwest consumption practices. Serving sizes were quantified in standard serving units or as small, medium and large servings. Food items selected for the FFQ/dietary screener were matched to foods from the United States Department of Agriculture (USDA) Continuing Survey of Food Intakes by Individuals (CSFII). Calcium, caffeine and alcohol values were assigned using CSFII data files at median values per 100g intake. CSFII midpoint tertile frequency of intake values for males and females 14-18 and 25-45 years old were used to establish serving weights for small, medium and large servings. CSFII data files provide an efficient way for estimating typical intakes, serving sizes and nutrient values for target groups. Age- and gender-derived data provided realistic estimates of nutrient intakes when using FFQ/dietary screener assessment method.

Food composition data: the foundation of dietetic practice and research.

Food composition databases and dietary assessment systems are important tools for food and nutrition professionals. The availability and accessibility of data have improved over time along with the technology to convert the information into useful formats for planning diets, writing educational materials, counseling patients, and conducting research. Primary sources of food composition data include government, academic, and other institutional databases; the food industry; and scientific literature. Changes in the marketplace affect food availability and composition and affect the accuracy and adequacy of food composition databases. Improvements in both food composition data and in dietary assessment methods have worked synergistically to improve estimates of dietary intake. The development of databases for food frequency assessment systems requires special considerations for data aggregation for each food or food grouping in the questionnaires. Considerations for selecting a dietary assessment system include appropriateness of the data for the intended audience or purpose, efficiency of the search strategy for retrieving data, content and format of summary information, and cost. Needs for food composition data vary depending on dietetic practice area; however, most food and nutrition professionals will benefit from becoming more informed about food composition data, exploring new ways to educate themselves about databases and database systems, and advocating for what is most needed in dietetic practice.

Diet quality in young children is influenced by beverage consumption.

BACKGROUND: Replacement of milk with sugar-containing beverages could affect calcium intake and overall diet quality. OBJECTIVE: To describe dairy food, 100% juice and added sugar beverage intakes, contributions of dairy foods to diet quality, and effects of beverages on diet quality in young children. METHODS: We surveyed participants in the Iowa Fluoride Study (n = 645) at ages 1, 2, 3, 4 and 5 years and calculated intakes for 1-5 years (i.e. weighted averages). Nutrient, dairy food and beverage intakes were obtained from 3-day diaries; nutrient adequacy ratios were calculated as the nutrient intake to Recommended Dietary Allowance/Adequate Intake ratio; and dairy-dependent percentages were calculated as fractions of total diet nutrient adequacy ratios (truncated at 1) not met by non-dairy foods. RESULTS: Milk intakes were inversely associated with intakes of juice drinks (2, 4, 5 and 1-5 years), soda pop (2, 3, 4, 5 and 1-5 years) and added sugar beverages (2, 3, 4, 5 and 1-5 years). Dairy dependent fractions of 1-5 year nutrient adequacy ratios were 68% for calcium and 61% for vitamin D. Higher 1-5 year calcium adequacy was predicted by higher energy, higher other dairy and lower added sugar beverage intakes while higher vitamin D adequacy was predicted by higher energy and higher other dairy intakes. Overall diet quality was predicted by higher energy, higher other dairy, lower 100% juice and lower added sugar beverage intakes. CONCLUSIONS: Dairy foods remain an important source of calcium and vitamin D, while added sugar beverages and, to a lesser extent, 100% juice decrease diet quality of young children.

Associations between Intakes of fluoride from beverages during infancy and dental fluorosis of primary teeth.

OBJECTIVE: We describe associations between primary tooth fluorosis status and intakes of beverages and fluoride from these beverages during infancy. METHODS: Subjects (n = 677) are members of the Iowa Fluoride Study, a cohort of young children followed from birth. Food and nutrient intakes were obtained from 3-day diet records. Diets were analyzed at 6 weeks, 3, 6, 9, 12 and 16 months and cumulatively for 6 weeks through 16 months of age. Primary tooth fluorosis was assessed at 4.5-6.9 years of age and defined as present or absent. Multiple logistic regression analyses were used to develop models to predict fluorosis status. RESULTS: Water-based beverage intakes were higher in subjects with fluorosis than in those without. Specifically, higher intakes of water used to reconstitute formulas at 3, 6 and 9 months; any intake of water as a beverage at 16 months; and higher intakes of combined 100% juice and miscellaneous beverages at 16 months were positively associated with fluorosis (p < 0.05). Fluoride intakes from water sources were also higher in subjects with fluorosis than in those without. Specifically, higher intakes of fluoride from water used to reconstitute formulas at 3, 6, 9 and 12 months and for 6 weeks through 16 months, and higher intakes of fluoride from water as a beverage at 16 months and for 6 weeks through 16 months were positively associated with fluorosis (p < 0.05). CONCLUSION: Infant beverages, particularly infant formulas prepared with fluoridated water, can increase the risk of fluorosis in primary teeth.

Patterns of beverage consumption during the transition stage of infant nutrition.

We describe beverage intakes during the transition stage of infant nutrition. Mean daily intakes of infant formula, cow's milk, combined juice and juice drinks, water, and other beverages estimated from a beverage frequency questionnaire were analyzed cross-sectionally at ages six through 24 months (n=701). Most children (97%) consumed human milk, infant formula, or cows' milk at each age studied. Mean daily intakes of combined infant formula and cows' milk declined from 28.0 oz at six months to 12.1 oz at 24 months. The percentage of children consuming juice and/or juice drinks increased with age, and mean daily consumption peaked at 9.1 oz at 20 months. Combined formula and cows' milk intakes were inversely associated with juice and juice drink intakes at all ages (-0.25 < r < 0; P<.01). Juice and juice drinks appear to replace formula and milk intakes during the transition stage of infant nutrition.

Dental caries and beverage consumption in young children.

OBJECTIVE: Dental caries is a common, chronic disease of childhood. The impact of contemporary changes in beverage patterns, specifically decreased milk intakes and increased 100% juice and soda pop intakes, on dental caries in young children is unknown. We describe associations among caries experience and intakes of dairy foods, sugared beverages, and nutrients and overall diet quality in young children. METHODS: Subjects (n = 642) are members of the Iowa Fluoride Study, a cohort followed from birth. Food and nutrient intakes were obtained from 3-day diet records analyzed at 1 (n = 636), 2 (n = 525), 3 (n = 441), 4 (n = 410), and 5 (n = 417) years and cumulatively for 1 through 5 (n = 396) years of age. Diet quality was defined by nutrient adequacy ratios (NARs) and calculated as the ratio of nutrient intake to Recommended Dietary Allowance/Adequate Intake. Caries were identified during dental examinations by 2 trained and calibrated dentists at 4 to 7 years of age. Examinations were visual, but a dental explorer was used to confirm questionable findings. Caries experience was assessed at both the tooth and the surface levels. Data were analyzed using SAS. The Wilcoxon rank sum test was used to compare food intakes, nutrient intakes, and NARs of subjects with and without caries experience. Logistic and Tobit regression analyses were used to identify associations among diet variables and caries experience and to develop models to predict caries experience. Not all relationships between food intakes and NARs and caries experience were linear; therefore, categorical variables were used to develop models to predict caries experience. Food and beverage intakes were categorized as none, low, and high intakes, and NARs were categorized as inadequate, low adequate, and high adequate. RESULTS: Subjects with caries had lower median intakes of milk at 2 and 3 years of age than subjects without caries. Subjects with caries had higher median intakes of regular (sugared) soda pop at 2, 3, 4, and 5 years and for 1 through 5 years; regular beverages from powder at 1, 4, and 5 years and for 1 through 5 years; and total sugared beverages at 4 and 5 years than subjects without caries. Logistic regression models were developed for exposure variables at 1, 2, 3, 4, and 5 years and for 1 through 5 years to predict any caries experience at 4 to 7 years of age. Age at dental examination was retained in models at all ages. Children with 0 intake (vs low and high intakes) of regular beverages from powder at 1 year, regular soda pop at 2 and 3 years, and sugar-free beverages from powder at 5 years had a decreased risk of caries experience. High intakes of regular beverages from powder at 4 and 5 years and for 1 through 5 years and regular soda pop at 5 years and for 1 through 5 years were associated with significantly increased odds of caries experience relative to subjects with none or low intakes. Low (vs none or high) intakes of 100% juice at 5 years were associated with decreased caries experience. In general, inadequate intakes (vs low adequate or high adequate intakes) of nutrients (eg, riboflavin, copper, vitamin D, vitamin B(12)) were associated with increased caries experience and low adequate intakes (vs inadequate or high adequate intakes) of nutrients (eg, vitamin B(12), vitamin C) were associated with decreased caries experience. An exception was vitamin E; either low or high adequate intakes were associated with increased caries experience at various ages. Multivariable Tobit regression models were developed for 1- through 5-year exposure variables to predict the number of tooth surfaces with caries experience at 4 to 7 years of age. Age at dental examination showed a significant positive association and fluoride exposure showed a significant negative association with the number of tooth surfaces with caries experience in the final model. Low intakes of nonmilk dairy foods (vs high intakes; all subjects had some nonmilk dairy intakes) and high adequate intakes of vitamin C (vs inadequate and low adequate intakes) were associated with fewer tooth surfaces having caries experience. High intakes of regular soda pop (vs none and low intakes) were associated with more tooth surfaces having caries experience. CONCLUSIONS: Results of our study suggest that contemporary changes in beverage patterns, particularly the increase in soda pop consumption, have the potential to increase dental caries rates in children. Consumption of regular soda pop, regular powdered beverages, and, to a lesser extent, 100% juice was associated with increased caries risk. Milk had a neutral association with caries. Associations between different types of sugared beverages and caries experience were not equivalent, which could be attributable to the different sugar compositions of the beverages or different roles in the diet. Our data support contemporary dietary guidelines for children: consume 2 or more servings of dairy foods daily, limit intake of 100% juice to 4 to 6 oz daily, and restrict other sugared beverages to occasional use. Pediatricians, pediatric nurse practitioners, and dietitians are in a position to support pediatric dentists in providing preventive guidance to parents of young children.

Relative validation of a beverage frequency questionnaire in children ages 6 months through 5 years using 3-day food and beverage diaries.

OBJECTIVE: To determine the relative validity of a quantitative beverage frequency questionnaire in assessing beverage, calcium, and vitamin D intakes using 3-day food diaries for reference. DESIGN: Parents were asked to complete questionnaires for the preceding week and diaries for the following week for their children. Calcium and vitamin D intakes were estimated from human milk, infant formulas, and cow's milk ("beverages") for questionnaires and diaries and from "all foods and beverages" for diaries. Data collected at 6 and 12 months and 3 and 5 years of age as part of the Iowa Fluoride Study (N=700) were analyzed cross-sectionally. SUBJECTS: Children (N=240); 60 randomly selected from each quartile of energy intake at 6 months of age. STATISTICAL ANALYSES: Spearman correlation coefficients, weighted kappa statistics, and percentages of exact agreement were used to assess associations between tools. RESULTS: Correlations between mean daily beverage intakes estimated from questionnaires and diaries ranged from 0.95-0.99 for human milk, 0.84-0.85 for infant formula, 0.63-0.86 for cow's milk, 0.54-0.69 for juice/drinks, 0.26-0.59 for liquid soft drinks, 0.35-0.74 for powdered soft drinks and 0.54-0.70 for water. Correlations between mean daily nutrient intakes estimated from questionnaires and diaries "beverages" ranged from 0.64-0.74 for calcium and 0.60-0.80 for vitamin D; and between questionnaires and diaries "all foods and beverages" ranged from 0.41-0.63 for calcium and 0.43-0.80 for vitamin D. APPLICATIONS: A quantitative beverage frequency questionnaire can provide a relative estimate of beverage, calcium, and vitamin D intakes.

Oral health, nutrient intake and dietary quality in the very old.

BACKGROUND: Limited food choices and inadequate nutrient intake are linked to poor oral health. The authors describe relationships between dietary variety, nutrient intake and oral health measures in community-dwelling, rural Iowans aged 79 years and older. METHODS: Dental examinations were conducted by trained and calibrated examiners, and trained interviewers completed standardized interviews in subjects' homes. Subjects (n = 220) then completed three-day dietary records. Adequate nutrient intakes were defined using the Dietary Reference Intakes of the Food and Nutrition Board of the National Academy of Sciences. RESULTS: Mean daily nutrient intakes were significantly lower in subjects who had fewer natural or functional teeth and ill-fitting mandibular dentures than in subjects who had more teeth or did not have these problems. Adequacy of intakes was lower in subjects who had fewer natural or functional teeth and ill-fitting mandibular dentures. Mean daily nutrient intakes did not differ between subjects with well-fitting dentures (either complete or partial) and subjects with natural teeth. Neither mean daily intake nor adequacy of intake was associated with subjects' perceptions of oral health problems, chewing difficulties or temperature sensitivity. CONCLUSIONS: The presence of natural teeth and well-fitting dentures were associated with higher and more varied nutrient intakes and greater dietary quality in the oldest old Iowans sampled. Clinical Implications. Maintenance of natural dentition or provision and maintenance of adequate mandibular prostheses are important for nutrient intakes to support systemic health.